CodeBlueBlog: CSI MEDBLOGS: FURTHER INVESTIGATING MARY McCLINTON'S DEATH...THE MEDICAL BLOGGISTS POOL EXPERTISE

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What follows is a comment left on this site, today, by Bard-Parker and my response, which is at first an apology for a disorganized post that got published prematurely, and then a follow-up on the story regarding Mary McClinton -- the Seattle woman who died horribly after disinfectant was accidently injected into her common femoral artery...I hope it clears up some of the misunderstandings generated by my post earlier.

Thanks to Dr. B-P.

From Dr. Bard-Parker:

The preps my radiologists use are breakable ampuoles within a plastic tube that fills a brush so such things can be avoided.

I have two aditional questions:

Aren't such post-coil films done with a power injector? If it was then the "technologist injection" may not be implausable since the tech would load the injector and push the button to begin the digital subtraction and injection.
How toxic is chlorhexidine? It is in things that range from Peridex mouthwash to Surgilube. I'm sure that it's not smart to inject such thing but how much would be required to have the effect advertized?

My Response:

First,let me apologize for how this post published. Typepad is driving me crazy today. This post published on first PREVIEW, before spellchecking, and also missing several key items including info/literature on chlorhexidine; pics and routine description regarding cerebral embolization technique; studies regarding the appropriateness of embolization therapy in nonruptured aneurysms, as well as which centers should be doing this procedure. Now TypePad is not letting me edit the post and my only recourse is to delete it, which I won't do; so, I will update this weekend with those missing data, in a second slightly more coherent format.

There used to be a fear that sponges and plastic applicators could "microfragment" and then become implanted during the Seldinger stick of the common femoral artery (this is the arterial puncture that begins the entire procedure) leading to foreign body granulomas, infections, etc. I think newer materials have eradicated that possibility and your guys are certainly using the right applicators; in fact VMMC is now using those same ampule-applicators.

I considered the whole chlorhexidine angle early on. I had the exact same thought as you do. It's hard to believe. I mean what did they do, inject a janitor's drum of that stuff in her?

There isn't much in the literature out there regarding intravenous administration of this stuff, so I didn't really have enough ammo to question this mechanism (I'll post my research over the weekend); and the couple of incidents regarding chlorhexidine complications seemed pretty dramatic. I realize that I could be missing a HUGE story, but I let it slide for two reasons: 1. I was going to come off as over-conspirational and thus undermine my credibility; and, 2. I have enough evidence to prove what I want to prove: that VMMC is using the "PR" game in an immoral way that, in the end, is going to back-fire and hurt EVERYONE in the medical field.

Most newer-trained neuroradiologists will use the power injector. In a recent survey, only 5 of 70 or so Rads said they were still ONLY hand injecting. I considered the power injector scenario and it raised an interesting point. The injector (which, depending on the model -- single or double barrell -- holds 60-300cc's of contrast) would have been filled at the beginning of the procedure. Surely they had done several limited runs before this last incident; so, if they were using the injector then there was CONTRAST in the injector. Each CCA run is about 10-12cc's and an ICA run is about 7-8cc's...it's hard to imagine they didn't load enough contrast.

But if they did miscalculate the amount of contrast needed then someone would have had to dip the nose of the power injector down into the chlorhexidine and manually crank it backwards into the injector and then rehook-up the catheter for that last, fatal injection.

That may well have happened, but there was no mention of any of these machinations in any reports.

If we assume they are telling the truth about the chlorhexidine injection, then I believe the most likely scenario is that someone grabbed a syringe, reached over and quickly sucked up fluid from the "wrong" bowl and injected it.

A hand injection can never be done by a technologist.

Even in the case of the power injector, the Doc is obligated to check the injector, and attach the tubing to the catheter himself before allowing the tech to operate the apparatus.

Question remains: how did they inject the patient's the leg? Were they doing the leg on the way out ( while removing the catheter after completing the cerebral exam) to work up claudication? Did they screw up the line (i.e. it stopped working and they couldn't figure out why), pull the catheter and inject the sheath (there is a sheath in the artery through which the catheters are exchanged) to see what's up?

COME CLEAN

One of the points I was heading to (until fouled by TypePad) was that I TOTALLY agree with the concept VMMC pays lip service to : coming clean. They should come clean and go from there. But, you see, they are not only NOT coming clean, they are, instead, putting on a dog and pony show concocted by their PR firm...and it is SO transparent it is insulting, and I don't think people will go for it for too long. Then, when the truth comes out, and it blows up into pieces it will engender MORE antipathy against physicians and fuel the litigating lions out there.

That's why my advice is for them to fess up and answer-up. In excruciating detail.

Maybe I'm too cynical (who me?) and VMMC is just REALLY bad at PR and didn't mean to present such a distracted, uncoordinated, illogical story to the public (after all, 160 consecutive media stories caught on to NONE of these contradictions)...because maybe those hospital administrators care less about their jobs then about the wide world of medical errors and patient safety. Maybe.

But it's also possible that the screw-up here is worse than "systems" failure and they are shucking oysters like mad hoping to bury us all in the shells...I know where I'd place MY bet.

Thanks for your letter.

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